1. Microbiology Risk Assessment in China: Current Situation & Challenges
Xiumei Liu
Institute of Nutrition and Food Safety
China CDC
July 25,2002

2. Risk Analysis
July 25,2002

3. RA A scientifically based process
RM The process of weighing policy alternatives, distinct from risk assessment
July 25,2002

4. MRA in the Word Foodborne bacteria Risk Assessment FAO/WHO （JEMRA）
Risk Management Codex （CCFH）
Mycotoxins, metabolites of fungi
Risk Assessment FAO/WHO （JECFA）
Risk Management Codex （CCFAC）
July 25,2002

5. China Activities in MRA
CCFH
Since 32nd 1999
JEMRA
Since 2000, Food hazard, EA, QMRA
CCFAC
Over 10 years, 32nd 2000 in Beijing
JECFA
Expert and data contribution
(AF, Fumonisin, DSP)
July 25,2002

6. Why MRA is needed in China？
WTO
CODEX / GB
FOOD INDUSTRY
FOOD SAFETY CONTROL
Government
Consumers
HEALTH PROTECTION
Life quality
knowledge
July 25,2002

7. Hazard Characterization Risk Characterization
Risk Assessment
Hazard Identification
Hazard Characterization
Exposure Assessment
Risk Characterization
July 25,2002

8. Toxic plants and animals Potential environmental toxicants
Hazards in Food
Foodborne bacteria
Fungi and mycotoxins
Viruses and parasites
Toxic plants and animals
Potential environmental toxicants
July 25,2002

9. Foodborne bacteria in China
Pathogens Mortality (%)
Salmonella
Bacillus cereus
Burkholderia cocovenenans 40
Proteus
Staphylococcus aureus
Clostridium botulinum 7.3
Escherichia coli
Vibrio parahaemolyticus
( )
July 25,2002

10. Case 1 BA Food Poisoning Control 1933. Indonesia:
Case 1 BA Food Poisoning Control Indonesia: Fermented coconut food poisoning Pseudomonas cocovenenans Bongkrekic acid 1950’s China: Unknown causes fermented corn flour poisoning Flavobacterium farinofermentans nov. sp China: Deteriorated tremella poisoning, P. cocovenenans subsp. farinofermentans Burkholderia cocovenenans (B. gladiali)
July 25,2002 8

11. Bongkrekic acid Food Poisoning Caused. by Various Food in China. Food
Bongkrekic acid Food Poisoning Caused by Various Food in China Food Provinces Outbreaks Patients Fatal Mortality cases (%) _______________________________________________________________ Cereal products Deteriorated tremella Potato product Total _______________________________________________________________ ( )
July 25,2002 19

12. Hazard identification: Bongkrekic acid, BA
Target Organs Liver Brain Kidney
Molecular formula
C28H38O7
LD50
3.16mg/kg
July 25,2002

13. Studies on the last 15 years l        Identification and examination of the foodnorne pathogen   l        Identification analysis and detoxication of BA   l        Diagnosis, monitor and prevention of food poisoning
July 25,2002 21

14. Risk Manegement in China. GB/T 4789. 29-94. Examination of P
Risk Manegement in China GB/T Examination of P. cocovenenans subsp. Farinofermentans GB Hygienic Standard of Tremella (BA Detection method) GB WT/ Diagnostic Criteria and Principle of Management for P. Cocovenenans subsp. farinofermentans Food Poisoning
July 25,2002 3

15. Outbreaks of BA reduced about 80%
BA poisoning control
Outbreaks of BA reduced about 80%
in 1990’s.
July 25,2002

16. Prevalence in fly feces
Mean: %
5th-95th: %-13.1%
Prevalence
Fig Distribution for E.coli prevalence in fly feces
——Beta(235, )
July 25,2002

17. Mar 21 Number of houseflies Month Average flies density
（no. of flies/cage·day）
Mar
Apr
May
June
July
Aug
Sep
July 25,2002

18. No. of ingested bacteria
Mean: 310 cfu/meal
5th-95th: 23～875cfu/meal
July 25,2002

19. Exposure probability
Mean: 63.5%
5th-95th: 59.5%～67.4%
July 25,2002

20. Natural toxicants --Actual and potential effects in humans
Acute effects
liver illness, poisoning, death
Aflatoxin, DON, 3-NPA, Ergot
Microcystin, Saxitoxins, Domoic acid, Solanine
Chronic effects
Carcinogenic, genotoxic & endemic illness
Aflatoxins, Fumonisins, Deoxynivalenol, Zearalenone, Ochratoxin A, Patulin, T-2 toxin, Moniliformine, Sterigmatocystin
Microcystin, Domoic acid, Cyanogenic glycosides
July 25,2002

21. Example: Aflatoxin B1
Animal toxicity data showed: it could cause primary liver cancer in most species studied
Epidemiological studies found an association between consumption of food contaminated with aflatoxin B1 and liver cancer
Is a genotoxic carcinogen
July 25,2002

22. Quantitative risk assessment at 49th JECFA Meeting
HBsAg (＋) :0.3 liver cancer/year/100,000/ ng AF/ kg bw/day
HBsAg (－) :0.01 liver cancer /year /100,000 / ng AF/kg bw/day
July 25,2002

23. HBsAg(＋) 1%; European Cont. level & Dietary Pattern
AFB1 intake Risk
(ng/day) (Cancer/year/100,000)
AFB1 limit 20 µg/kg ( )
AFB1 limit 10 µg/kg ( )
2 cancers/year/billion
July 25,2002

24. China cont. level and far east dietary pattern
AFB1 intake Risk
(ng/day) (Cancer/year/100,000)
AF limit 20 µg/kg ( )
AF limit 10 µg/kg ( )
300 cancers/year/billion
*The mortality of liver cancer was 20/100,000 in the period of (20.03/100,000)
July 25,2002

25. Case 2 The Control of the Deteriorated Sugarcane Food Poisoning in China
Fresh sugarcane grown in southern area of China
Usually shipped to northern parts of China, stored and sold through the winter season
Contaminated sugarcane can cause fatal food poisoning when sold in the next spring
July 25,2002

26. Sugarcane poisoning
The first outbreak of sugarcane poisoning with unknown causes occurred in Henan Province in 1972
From 1972 to 1989:
No. of outbreak:
No. of cases:
No. of deaths:
Average fatality: %
Identified as a priority to assess and control
July 25,2002

27. Characteristics of 34 MSP Cases Age:
Characteristics of 34 MSP Cases   Age: 3 to 27 years old Incubation period: 10 minutes to 8 hours Manifestations: Vomiting Dystonia Stare on one side Convulsion Carpopedal spasm Coma Electroencephalogram Sequelae
July 25,2002

28. Etiology and risk assessment
Etiology: the Chinese Academy of Preventive Medicine studied on the etiology of this specific food poisoning since 1984 and found:
Arthrinium spp. was the pathogenic fungus;
3-nitropropionic acid (3-NPA) produced by A. spp. was proved to be the causative compound
Assessment was made according to case-based studies, epidemiological and laboratory studies
July 25,2002

29. Decision making and management activities
Based on discovery and assessment, MOH promulgated:
Diagnostic criteria and principles for the management of deteriorated sugarcane poisoning (WS/T );
Methods for the isolation and identification of Arthrinium strains and analyzing 3-nitropropionic acid (GB )
At the same time, MOH issued a notification on the prevention and control of DSP to all provinces of China
A national health campaign for prevention and control of the poisoning was launched
July 25,2002

30. Prevention and control measures
The main measures adopted by local health inspectors:
Fresh sugarcane shipped to northern China should not be stored for more than 3 weeks
The deteriorated sugarcane with unpleasant smell and mold growing should not be sold in market
When poisoning outbreak occurred, the suspected left-over sugarcane should be immediately sealed and destroyed
During the outbreak, food inspectors and clinical doctors should work closely to identify and treat patients
July 25,2002

31. No typical cases were reported in China in the last 10 years!
Good results
As a result of these efforts, sugarcane poisoning has been satisfactory controlled
No typical cases were reported in China in the last 10 years!
July 25,2002

32. Challenges: Areas for Strengthening
Knowledge
Team （National level）
Practice （Data, Modeling）
Food consumption / dietary intake
Effects of processing
QMRA   (Quantitative method)
Analytical methods
Sampling protocols
July 25,2002

33. FAO/WHO Activates in China
Workshop on Microbiological Risk Assessment
Sponsored by FAO/ ILSI /WHO/ MOH
May 10-11, 2002 Beijing
Quantitative Microbiological Risk Assessment Training Course (David Vose)
Sponsored by WHO/INFS
May 13-24, 2002 Beijing
July 25,2002